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PERMITTEE NAME/ADDRESS (Include NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDR!) tl«mAppn9ed
<br /> faclllry Name/Caratlon If d10FnAl) 7 1 (DISCHARGE MONITORING REPORT(DAIR) OMB No.2000)00!
<br /> 1 11.f61 17-19
<br /> Approval ta(ptns IZ31$T
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<br /> MONITORING PERIOD
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<br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED �' Y v( - TELEPHONE D A T E
<br /> _ ANO AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN. AND BASED
<br /> ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR CI •I- -.� l�
<br /> OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION
<br /> IS TRUE ACCURATE AND COMPLETE 1 AM AWARE THAT THERE An SIG
<br /> NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING _ _ K•` L _
<br /> THE POSSIBILITY OF FOR
<br /> AND IMPRISONMENT SEC IB USC 1 1001 AND ('
<br /> 33 USC 11319. IRmInF. Dodo Mry Lururrx mar Include fmn up In t14nrR1 }SI NATURE OF-PbINCIPAL'E%ECUTIVE ''
<br /> ,. TYPED OR PRINTED P.dn.maslmum lmpn.Ilnnl.Ilr ll/A.tuwn XlmllntA.and.:.nr.I j�OFFICER.ORAUTHORIZED AC -- NUMBER IYEAR MO DAY
<br /> COMMENT AND,EXPLANATION OF ANY VIOLATIONS (Reference uR attachments here) n.., 5. 1S M1 j, ' h•. T= -e L y \_le
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<br /> _.� '!. -at :•-k-iT `)�; oPA., T �. �- 1L'.�b.:EPA Form 3320.1 (Rev. 10-79)PREVIOUS EDITION TO BE USED (REPLACSSI EPA FORM T-40 WHICH MAY NOT S[USED.) PAGE OF
<br /> UNTIL SUPPLY IS EXHAUSTED
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